MEDICARE: RONALD IRWIN PALMER MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PS005854L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	209105	OTHER	PA	UPMC
2	201297000	OTHER	PA	MAGELLAN
3	003763	OTHER	PA	VALUE OPTIONS
4	263728	OTHER	PA	BLUE SHIELD
5	716744	OTHER	PA	BLUE SHIELD

General Provider Information

NPI Number	:	1639194731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD IRWIN PALMER MA

Provider Business Mailing Address
First Line	:	100 SHENANGO AVE
Second Line	:
City	:	SHARON
State	:	PA
Zip	:	16146-1503
Country	:	US
Telephone Number	:	148-670-7950
Fax Number	:	814-670-7951

Provider Business Practice Location Address
First Line	:	811 GRANDVIEW RD STE 100
Second Line	:
City	:	OIL CITY
State	:	PA
Zip	:	16301-2077
Country	:	US
Telephone Number	:	814-670-7950
Fax Number	:	814-670-7951

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	10/03/2023

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